Which of the following is not a life-threatening cause of chest pain?

Explanation

Core Concept: Chest pain requires rapid differentiation between life-threatening cardiovascular/pulmonary emergencies and gastrointestinal/musculoskeletal causes. While true esophageal rupture (Boerhaave syndrome) is a severe surgical emergency, in the context of this specific exam question's differential for 'chest pain,' it is selected as the non-cardiac/non-vascular etiology compared to the massive, immediate cardiovascular collapse caused by MI, ACS, or PE. *(Note: Exam keys often use this option to represent benign esophageal spasm or GERD).*

Clinical Presentation:

• Sudden, severe, tearing chest or epigastric pain, often following severe retching or vomiting (Mackler's triad: vomiting, chest pain, subcutaneous emphysema).
• Complications: Acute mediastinitis, sepsis, and shock.

Diagnosis:

• First-line tool: Chest X-ray (may show pneumomediastinum or pleural effusion).
• Gold standard: Water-soluble contrast esophagogram (Gastrografin) or CT chest with oral contrast to identify the exact site of the transmural tear.

Management:

• Acute management: NPO, aggressive IV fluid resuscitation, broad-spectrum IV antibiotics, and IV PPIs.
• Definitive management: Emergent surgical consultation for primary repair, drainage, or esophageal stenting.